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No. 2082
Form
TRIPLICATE
de -
the Declaration)
Honorable
the
STATES OF
The
First.
Second.
Third.
Department of Commerte and Tabor
Fourth.
BUREAU OF IMMIGRATION AND NATURALIZATION
Domina
DIVISION OF NATURALIZATION
anno Domini 190
Phil
gecla
DECLARATION OF INTENTION
Stath. I am
(Invalid for all purposes seven years after the date hereof)
in
Statef Wisceneme
chu
In the bivent
Court
SS :
bunity of Price
of Puin beventy
the
3. Henry Balhen
aged 21 years,
hada
occupation
Common labinent
do declare on oath
,
affirm
that my personal
Seventh. I an
description is: Color White complexion Light , height 6 feet
= inches,
to governi
weight 175 Brown
pounds, color of hair , color, of eyés Gray
intention become
other visible distinctive marks none
particularly to
to reside permanenti
;
I was born in Chrudim Bohnna
I
am
Nth
Minth.
have
on the
day of July
anno
day
Domini I I now reside , at Philling Wisconsin
petition, since the
emigrated the United from Bohnnia
petition.
I to States of America
Tenth. have
on the vessel
Rotter Sam
; my last
foreign residence was chindim Bohnna
petétion de
It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign
Attached heret
together
prince, potentate, state, or sovereignty, and particularly to Francis Joseph
the United States
Emparior of Austria - Hungary
of which I am now a subject citizen I
State arrived` at the port of New York
in the
Declaration of Inter
,
Territory
of New york
on or about the
12th
District
day
of December
anno Domini I 905 I am not an anarchist: 1 am not
a
STATE o.
Caunty
polygamist nor a believer in the practice of polygamy: and it is my intention in good faith
to become a citizen of the United States of America and to permanently reside therein
The aforesald
contents thereof t/
So HELP ME GOD.
information and bell
Henry Bachur
(Origioal signature of declarani.)
the
Subscribed and sworn to before me this
11th
affirmed
and
ga
[SEAL ]
Jms.
day of anno Domini 1907
each
Her
Also Rammossm
immediately precedín
the burnut
ensitled potition is
Clerk of
Court.
the sald la
Clerk.
and
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- Type
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"ocrText": "to any\nhat\nx\nNo. 2082\nForm\nTRIPLICATE\nde -\nthe Declaration)\nHonorable\nthe\nSTATES OF\nThe\nFirst.\nSecond.\nThird.\nDepartment of Commerte and Tabor\nFourth.\nBUREAU OF IMMIGRATION AND NATURALIZATION\nDomina\nDIVISION OF NATURALIZATION\nanno Domini 190\nPhil\ngecla\nDECLARATION OF INTENTION\nStath. I am\n(Invalid for all purposes seven years after the date hereof)\nin\nStatef Wisceneme\nchu\nIn the bivent\nCourt\nSS :\nbunity of Price\nof Puin beventy\nthe\n3. Henry Balhen\naged 21 years,\nhada\noccupation\nCommon labinent\ndo declare on oath\n,\naffirm\nthat my personal\nSeventh. I an\ndescription is: Color White complexion Light , height 6 feet\n= inches,\nto governi\nweight 175 Brown\npounds, color of hair , color, of eyés Gray\nintention become\nother visible distinctive marks none\nparticularly to\nto reside permanenti\n;\nI was born in Chrudim Bohnna\nI\nam\nNth\nMinth.\nhave\non the\nday of July\nanno\nday\nDomini I I now reside , at Philling Wisconsin\npetition, since the\nemigrated the United from Bohnnia\npetition.\nI to States of America\nTenth. have\non the vessel\nRotter Sam\n; my last\nforeign residence was chindim Bohnna\npetétion de\nIt is my bona fide intention to renounce forever all allegiance and fidelity to any foreign\nAttached heret\ntogether\nprince, potentate, state, or sovereignty, and particularly to Francis Joseph\nthe United States\nEmparior of Austria - Hungary\nof which I am now a subject citizen I\nState arrived` at the port of New York\nin the\nDeclaration of Inter\n,\nTerritory\nof New york\non or about the\n12th\nDistrict\nday\nof December\nanno Domini I 905 I am not an anarchist: 1 am not\na\nSTATE o.\nCaunty\npolygamist nor a believer in the practice of polygamy: and it is my intention in good faith\nto become a citizen of the United States of America and to permanently reside therein\nThe aforesald\ncontents thereof t/\nSo HELP ME GOD.\ninformation and bell\nHenry Bachur\n(Origioal signature of declarani.)\nthe\nSubscribed and sworn to before me this\n11th\naffirmed\nand\nga\n[SEAL ]\nJms.\nday of anno Domini 1907\neach\nHer\nAlso Rammossm\nimmediately precedín\nthe burnut\nensitled potition is\nClerk of\nCourt.\nthe sald la\nClerk.\nand"
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